Online CPR Certification Blog

Date: February 25th, 2014

The announcement was made in a letter that was sent last month to the state Medicaid directors and it removes the restrictions imposed back in 1997 as provided for in the Balanced Budget Act, the rules that the Clinton administration issued back in January 2001 as well as by Bush administration back in January 2001. According to the law enacted in 1997, states could require beneficiaries of Medicaid to enroll either for MCOs like HMO.

The law also requires that MCOs provide emergency service coverage as a safeguard in those cases which a prudent layperson, meaning an individual having just an average knowledge on medicine and health, would consider seeking emergency services important. In addition to this, the law allows the Medicaid beneficiaries to enroll in the MCO in order to be able to access emergency services at the nearest service provider immediately, as reported by the AP/ Washington post.

Appropriate use of health care services

But according to a letter that the HHS director of Center for Medicaid & State Operations, Dennis Smith sent, Bush administration had scrapped off the MCOs requirements. According to the administration, they had decided that a state could place certain limitations on emergency service coverage in efforts of ensuring that the public uses primary health care and preventive care services appropriately.

Reaction from different angles on the proposed policy

According to the officials of Bush administration, this decision would go a long way in allowing the states to have much greater flexibility when it comes to operating their Medicaid programs, as reported by the Times. According to Gregory Vadner, which Medicaid director in Missouri and the vice chairperson of National Association of State Medicaid Directors, some of the states felt that the old policy constricted and restricted them so much. During times when the states are experiencing fiscal stress, it is very important that they have the discretion of managing the programs properly. Cindy Man, who is a Medicaid expert based at Georgetown University, however raised questions on whether the policy was really legal. The move was also seriously criticized by some law makers as well.

According to Senator Bob Graham who was one of the main authors of the law enacted in 1997, this decision would significantly undermine accessibility to important emergency services, mostly affecting low income Americans. Graham wrote a letter to president Bush saying that the new policy on HHS seems to be allowing MCOs like HMOs to deny children, low income earners, seniors and disabled individuals the chance of accessing the much needed services in case they need emergency services. In the Letter, he urged Bush to seriously reconsider the decision as it was very unwise.